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City: State: ZIP: <br /> Contact name: Phone: <br /> Email: <br /> Proposed number of seats: <br /> ❑ Yes ❑ No Are you a newly constructed facility? <br /> ❑ Yes ❑ No Are you making changes to an existing facility? <br /> ❑ Yes ❑ No Do you have an approved grease interceptor in your facility? <br /> Your local water/sewer district may require an approved grease interceptor to be installed in the facility. We <br /> recommend contacting your local water/sewer agency for information regarding grease interceptor installation. <br /> WATER SYSTEM <br /> This section should be completed by contacting your local public water system official (if different from sewer) and <br /> informing them of the scope of your project and proposed new facility address. If necessary, a letter of availability <br /> may be provided for new construction. <br /> Name of Public Water Utility Provider: <br /> Full Name of Water System Official: Phone: Signature of Water System Official: Date: <br /> WASTEWATER SYSTEM <br /> Which type of wastewater system will your facility be connected to? <br /> ❑ Public Sewer System ❑ On-site Septic System (Initial) <br /> On the next page: <br /> Fill out the Public Sewer System section if you are planning on being connected to a public sewer system. <br /> Fill out the On-site Septic System section if you are planning on being connected to an on-site septic <br /> system. <br /> Environmental Health Division <br /> 3020 Rucker Avenue, Suite 104 ■ Everett, WA 98201-3900 ■ fax: 425.339.5254 ■ tel: 425.339.5250 <br /> AGENCY LIST: <br /> Water and Sewer Agencies Contact <br /> Alderwood Water and 425-787-0220, www.awwd.com <br /> Wastewater District <br /> Lake Stevens Sewer District 425-334-8588, www.lkstevensseswer.org <br /> Silver Lake Water and Sewer District 425-337-3647, https:Hslwsd.com/ <br /> Building Departments <br />